Drowning Mortality in the United States, 1999–2006

Drowning is the fifth leading cause of unintentional fatalities in the US. Our study described demographics and trend analysis of unintentional drowning mortality in the US from 1999 to 2006, and identifies the changes in deaths for specific population subgroups. Mortality data came from the CDC’s Web-based Injury Statistics Query and Reporting System. Trends during 1999–2006 were analyzed by gender, age group and race. Annual percentage change in deaths/rates and simple linear regression was used for time-trend analysis from 1999 to 2006, and examines its significance. During 1999–2006, there were 27,514 deaths; 21,668 (78.8%) males, 21,380 (77.7%) whites, and 4,241 (15.4%) aged 00–04 years. The annual number of drowning mortality varied from a high of 3,529 in 1999 to a low of 3,281 in 2001. Overall, deaths were increased 1.4% from 3,529 during 1999 to 3,579 deaths during 2006 however, the overall mortality rate decreased by 5%. The proportion of deaths was significantly greater among males than females (27.4 vs. 13.7%: p < 0.001) and blacks than among all other races combined (32.5 vs. 21.3%: p < 0.001). Fatalities reported from California (n = 3,234; 11.75%), Florida (n = 2,852; 10.37%) and Texas (n = 2,395; 8.70%) accounted for 30.82% of all such deaths in the US. Sub-group analyses showed that drowning mortality decreased 0.72% for males but increased 9.52% for females, the trend differ significantly among males and females (p < 0.001). Males, American Indians, and blacks appear to have higher risk of drowning mortality. The trend varied among sexes, age and racial groups from 1999 to 2006. Preventive measures and continuous surveillance is warranted to further decrease these drowning mortalities.     

Stroke and active life expectancy in the United States, 1999–2009

BackgroundStroke reduces active life expectancy, both years lived and their proportion without disability. However, active life expectancy studies have provided limited information about strokes in the United States, those occurring throughout older life, or those affecting African Americans.ObjectiveTo measure associations between strokes throughout older life and active life expectancy for African American and White women and men.MethodsUsing data from the Panel Study of Income Dynamics, 1999–2009 (n = 1862, 13,603 person-years), we estimated monthly probabilities of death and disability in activities of daily living with multinomial logistic Markov models adjusted for age, sex, ethnicity, stroke in the past two years, earlier stroke, and education. A random effect accounted for the panel data repeated measures. Microsimulation created large populations with stroke incidence throughout older life, identifying life expectancy and the proportions of remaining life with and without disability. We matched individuals with strokes with randomly selected persons without strokes by age at first stroke, sex, ethnicity, and previous disability.ResultsAverage age at first stroke was higher for women, lower for African Americans. African American and White women were disabled for about two-thirds of life after stroke; results for men were 61.8% for African Americans and 37.2% for Whites. Compared to matched participants, those with strokes lived 33% fewer remaining years (95% confidence interval, CI 30.9%–34.7%) with a 31.6% greater proportion of remaining life with disability (CI 14.4%–55.6%).ConclusionsStroke greatly reduces both life expectancy and the proportion of life without disability, particularly for women and African Americans.     

Characteristics of Tuberculosis Cases that Started Outbreaks in the United States, 2002–2011

A review of 26 tuberculosis outbreaks in the United States (2002–2011) showed that initial source case-patients had long infectious periods (median 10 months) and were characterized by substance abuse, incarceration, and homelessness. Improved timeliness of diagnosis and thorough contact investigations for such cases may reduce the risk for outbreaks.     

Carbapenem-Resistant Enterobacteriaceae in Children,United States, 1999–2012

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infections is increasing in the United States. However, few studies have addressed their epidemiology in children. To phenotypically identify CRE isolates cultured from patients 1–17 years of age, we used antimicrobial susceptibilities of Enterobacteriaceae reported to 300 laboratories participating in The Surveillance Network–USA database during January 1999–July 2012. Of 316,253 isolates analyzed, 266 (0.08%) were identified as CRE. CRE infection rate increases were highest for Enterobacter species, blood culture isolates, and isolates from intensive care units, increasing from 0.0% in 1999–2000 to 5.2%, 4.5%, and 3.2%, respectively, in 2011–2012. CRE occurrence in children is increasing but remains low and is less common than that for extended-spectrum β-lactamase–producing Enterobacteriaceae. The molecular characterization of CRE isolates from children and clinical epidemiology of infection are essential for development of effective prevention strategies.     

Comparing Characteristics of Sporadic and Outbreak-Associated Foodborne Illnesses,United States, 2004–2011

Outbreak data have been used to estimate the proportion of illnesses attributable to different foods. Applying outbreak-based attribution estimates to nonoutbreak foodborne illnesses requires an assumption of similar exposure pathways for outbreak and sporadic illnesses. This assumption cannot be tested, but other comparisons can assess its veracity. Our study compares demographic, clinical, temporal, and geographic characteristics of outbreak and sporadic illnesses from Campylobacter, Escherichia coli O157, Listeria, and Salmonella bacteria ascertained by the Foodborne Diseases Active Surveillance Network (FoodNet). Differences among FoodNet sites in outbreak and sporadic illnesses might reflect differences in surveillance practices. For Campylobacter, Listeria, and Escherichia coli O157, outbreak and sporadic illnesses are similar for severity, sex, and age. For Salmonella, outbreak and sporadic illnesses are similar for severity and sex. Nevertheless, the percentage of outbreak illnesses in the youngest age category was lower. Therefore, we do not reject the assumption that outbreak and sporadic illnesses are similar.     

HIV Diagnoses and Prevalence in the Southern Region of the United States, 2007–2010

On a number of leading health indicators, including HIV disease, individuals in the southern states of the United States fare worse than those in other regions. We analyzed data on adults and adolescents diagnosed with HIV infection through December 2010, and reported to the Centers for Disease Control and Prevention (CDC) through June 2011 from 46 states with confidential name-based HIV reporting since January 2007 to describe the impact of HIV in the South. In 2010 46.0 % of all new diagnoses of HIV infection occurred in the South. Compared to other regions, a higher percentage of diagnoses in the South were among women (23.8 %), blacks/African Americans (57.2 %), and among those in the heterosexual contact category (15.0 % for males; 88.5 % for females). From 2007 to 2010 the estimated number and rate of diagnoses of HIV infection decreased significantly in the South overall (estimated annual percentage change [EAPC] = ?1.5 % [95 %CI ?2.3 %, ?0.7 %] and ?2.1 % [95 % CI ?4.0 %, ?0.2 %], respectively) and among most groups of women, but there was no change in the number or rate of diagnoses of HIV infection among men overall. Significant decreases in men 30–39 and 40–49 years of age were offset by increases in young men 13–19 and 20–29 years of age. A continued focus on this area of high HIV burden is needed to yield success in the fight against HIV disease.     

Epidemiology of Human Plague in the United States, 1900–2012

We summarize the characteristics of 1,006 cases of human plague occurring in the United States over 113 years, beginning with the first documented case in 1900. Three distinct eras can be identified on the basis of the frequency, nature, and geographic distribution of cases. During 1900–1925, outbreaks were common but were restricted to populous port cities. During 1926–1964, the geographic range of disease expanded rapidly, while the total number of reported cases fell. During 1965–2012, sporadic cases occurred annually, primarily in the rural Southwest. Clinical and demographic features of human illness have shifted over time as the disease has moved from crowded cities to the rural West. These shifts reflect changes in the populations at risk, the advent of antibiotics, and improved detection of more clinically indistinct forms of infection. Overall, the emergence of human plague in the United States parallels observed patterns of introduction of exotic plants and animals.     

Tooth Loss in Appalachia and the Mississippi Delta Relative to Other Regions in the United States, 1999–2010

Objectives. We examined regional variation in tooth loss in the United States from 1999 to 2010.Methods. We used 6 waves of the Behavioral Risk Factor Surveillance System and data on county characteristics to describe regional trends in tooth loss and decompose diverging trends into the parts explained by individual and county components.Results. Appalachia and the Mississippi Delta had higher levels of tooth loss than the rest of the country in 1999. From 1999 to 2010, tooth loss declined in the United States. However, Appalachia did not converge toward the US average, and the Mississippi Delta worsened relative to the United States. Socioeconomic status explained the largest portion of differences between regions in 1999, but a smaller portion of the trends. The Mississippi Delta is aging more quickly than the rest of the country, which explains 17% of the disparity in the time trend.Conclusions. The disadvantage in tooth loss is persistent in Appalachia and growing in the Mississippi Delta. The increasing disparity is partly explained by changes in the age structure but is also associated with behavioral and environmental factors.People in Appalachia have worse oral health than other Americans.1–4 West Virginia, the only state entirely located in Appalachia, has the highest rate of people missing 6 or more teeth (65.6%) and the second highest rate of complete tooth loss (37.8%) for people aged 65 years and older.5,6 The Mississippi Delta, another economically disadvantaged region, also has poor oral health. Mississippi, which falls mostly in the Mississippi Delta, follows West Virginia with the second highest rate of people missing 6 or more teeth (58.2%) and the fourth highest rate of complete tooth loss (27.3%) among those aged 65 years and older.5,6 Of the 5 states with the highest rate of people missing 6 or more teeth, 4 fall in the Mississippi Delta or Appalachia.Numerous studies have examined the causes of poor oral health in Appalachia and the Mississippi Delta. Studies have highlighted the importance of both individual attributes and broader elements that affect Appalachian communities. Individual attributes include socioeconomic status (SES), genetics, oral bacteria, tobacco use, knowledge of health behaviors, and dental insurance.1,2,4,7–9 Broader elements include fluoride in the water supply, cultural importance placed on oral health, presence of coal mining, and number of dentists and dental hygienists per capita.1,2,4,10,11 Less research has been done on oral health in the Mississippi Delta, although this region also has high rates of tooth loss. Studies that have analyzed this region have highlighted the roles of race, private dental insurance, parental oral health, parental health behaviors, and diet.12–15Oral health in the United States has significantly improved in the past 4 decades. The number of decayed, missing, and filled teeth; prevalence of untreated caries; edentulous rate; and rate of periodontal disease have all declined.16–22 The overall improvement in oral health outcomes in the United States raises the question of whether all areas of the United States are improving equally or whether there are persistent regional disparities in oral health outcomes. Previous reports from the Centers for Disease Control and Prevention have provided raw data on tooth loss in each state,5,6 but data on regional disparities is lacking. Moreover, without microdata it is impossible to discern whether divergent regional trends are attributable to relatively innocuous differences, such as the age structure of the regions, or driven by more concerning disparities, such as poverty and access to oral health care.To address this gap, we used data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine regional variation in the level and improvement in the rate of tooth loss from 1999 to 2010. Our regions of interest, Appalachia and the Mississippi Delta, are defined as groups of counties. We analyzed the association between tooth loss and individual characteristics, individual behavior, and county factors.We tested 3 hypotheses: (1) The Mississippi Delta and Appalachia will have had less improvement in oral health than the rest of the country in the past decade, (2) the age profile of the regions will explain a portion of the regional differences, and (3) individual characteristics, individual behavior, and county characteristics will explain a portion of the regional differences.     

Racial Residential Segregation and Rates of Gonorrhea in the United States, 2003–2007

Objectives. In the United States, Black persons are disproportionately affected by sexually transmitted infections (STIs), including gonorrhea. Individual behaviors do not fully explain these racial disparities. We explored the association of racial residential segregation with gonorrhea rates among Black persons and hypothesized that specific dimensions of segregation would be associated with gonorrhea rates.Methods. We used 2003 to 2007 national STI surveillance data and 2000 US Census Bureau data to examine associations of 5 dimensions of racial residential segregation and a composite measure of hypersegregation with gonorrhea rates among Black persons in 257 metropolitan statistical areas, overall and by sex and age. We calculated adjusted rate ratios with generalized estimating equations.Results. Isolation and unevenness were significantly associated with gonorrhea rates. Centralization was marginally associated with gonorrhea. Isolation was more strongly associated with gonorrhea among the younger age groups. Concentration, clustering, and hypersegregation were not associated with gonorrhea.Conclusions. Certain dimensions of segregation are important in understanding STI risk among US Black persons. Interventions to reduce sexual risk may need to account for racial residential segregation to maximize effectiveness and reduce existent racial disparities.Sexually transmitted infections (STIs) remain an important public health problem in the United States, with approximately 19 million new infections per year.1 Black persons, especially adolescents, bear a disproportionate burden of most STIs, including gonorrhea.2–6 In 2008, rates of gonorrhea were highest among Black individuals, aged 15 to 19 and 20 to 24 years, compared with any other racial/ethnic and age groups.7,8 Among 15- to 19-year-old adolescents, rates of gonorrhea were nearly 21 times higher for Black (2201.9 per 100 000) than for White adolescents (107.0 per 100 000).7 Untreated gonorrhea can have serious and long-term sequelae, including the facilitation of HIV transmission, infertility, and adverse outcomes for infants born to infected mothers.8Exposure to and infection with STIs are conditioned by many factors, including individual behaviors, relationship patterns, and characteristics of the social environment. Substantial attention has been paid to differences in individual risk behaviors, such as condom use and number of sexual partners, but they do not fully explain racial disparities in STI risk.4 Therefore, focusing solely on these proximate factors to reduce risk and disparities may have only limited effect.4,9 A growing body of research has examined the contribution of contextual factors, such as neighborhood attributes, to sexual risk. Specifically, numerous studies have examined whether living in a neighborhood with lower socioeconomic status is associated with sexual risk behaviors, such as younger age at first sexual intercourse and unprotected sexual intercourse.10–20 The findings have been equivocal, with some showing an association and others not. Therefore, a better understanding of the possible effects of other contextual factors on sexual risk is necessary.Racial residential segregation—the extent to which 2 or more racial groups live separate from one another in a metropolitan area—is a characteristic of the social environment that many Black individuals continue to experience.21 Nearly two thirds of Black persons live in highly segregated areas.9 The available evidence suggests that Black individuals living in more segregated areas, compared with less segregated areas, are at higher risk for certain poor health outcomes, such as low birth weight, mental health conditions, and mortality.9,22–28 No published studies to date have examined the association of racial residential segregation with sexual risk, but recent commentary has identified racial residential segregation as a possible cause of disparities in sexual risk.5,9,22,29–31Racial residential segregation, which describes the racial composition of neighborhoods and the spatial distribution of these neighborhoods in larger metropolitan areas, may be more conceptually relevant to understanding racial disparities than are individual and neighborhood characteristics because it captures the unequal structure for Black and White people across the entire housing market. It has been conceptualized in 5 distinct dimensions—exposure, concentration, centralization, clustering, and unevenness. Metropolitan areas are defined by

1. low exposure (or isolated) if minority members do not often share neighborhoods with other groups,
2. concentrated if minorities occupy relatively little physical space per capita,
3. centralized if minorities are more likely to live in neighborhoods around an urban core relative to other groups,
4. clustered if minorities live in neighborhoods that are crowded together to form a large enclave, and
5. uneven if minorities are overrepresented in some neighborhoods and underrepresented in other neighborhoods.32

Racial residential segregation is hypothesized to lead to differential exposure to STIs through a variety of mechanisms. First, segregation might lead to increased rates of STIs among Black persons by affecting the sexual network (e.g., partner availability and density of individuals).5,31 Second, segregation may create or foster environments (e.g., restricted economic and employment opportunities, disordered neighborhoods) that are conducive to sexual risk behaviors and increased STI risk.9,24,29,31 Each dimension of segregation may have varying degrees of salience in describing distinct mechanisms that affect sexual risk and STI transmission.22,24,31 According to a conceptual model proposed by Acevedo-Garcia,22 exposure, concentration, and, to a lesser extent, centralization are relevant to understanding infectious disease risk because of their effect on transmission patterns and social networks.We used 5 years of national sexually transmitted disease (STD) surveillance data to study the associations of racial residential segregation with gonorrhea rates among Black people in the United States at the metropolitan statistical area (MSA) level. According to Acevedo-Garcia’s model, we hypothesized that certain dimensions of segregation, such as exposure and concentration, would be more positively associated with gonorrhea rates compared with other dimensions of segregation. Additionally, we hypothesized that the associations would be modified by sex and age because of differences across sex and age groups in patterns of social influence.     

State minimum wages and health insurance coverage in the United States: 2008–2018

International Journal of Health Economics and Management - This study examines the effect of minimum wage hikes on the shares of uninsured people during the period 2008–2018. Despite some...     

Cat-Scratch Disease in the United States, 2005–2013

Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005–2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5–9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50–64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children.     

The Association Between Race/Ethnicity and Major Birth Defects in the United States, 1999–2007

Objectives. We investigated the relationship between race/ethnicity and 27 major birth defects.Methods. We pooled data from 12 population-based birth defects surveillance systems in the United States that included 13.5 million live births (1 of 3 of US births) from 1999 to 2007. Using Poisson regression, we calculated prevalence estimates for each birth defect and 13 racial/ethnic groupings, along with crude and adjusted prevalence ratios (aPRs). Non-Hispanic Whites served as the referent group.Results. American Indians/Alaska Natives had a significantly higher and 50% or greater prevalence for 7 conditions (aPR = 3.97; 95% confidence interval [CI] = 2.89, 5.44 for anotia or microtia); aPRs of 1.5 to 2.1 for cleft lip, trisomy 18, and encephalocele, and lower, upper, and any limb deficiency). Cubans and Asians, especially Chinese and Asian Indians, had either significantly lower or similar prevalences of these defects compared with non-Hispanic Whites, with the exception of anotia or microtia among Chinese (aPR = 2.08; 95% CI = 1.30, 3.33) and Filipinos (aPR = 1.90; 95% CI = 1.10, 3.30) and tetralogy of Fallot among Vietnamese (aPR = 1.60; 95% CI = 1.11, 2.32).Conclusions. This is the largest population-based study to our knowledge to systematically examine the prevalence of a range of major birth defects across many racial/ethnic groups, including Asian and Hispanic subgroups. The relatively high prevalence of birth defects in American Indians/Alaska Natives warrants further attention.Birth defects are a leading cause of infant mortality, accounting for 1 in 5 infant deaths in the United States, and these defects contribute substantially to childhood and adult disability, as well as to health care costs.1–3 The examination of racial/ethnic variations in birth defects provides clues regarding their etiology from genetic, cultural, environmental, and other factors. The United States has a relatively large, diverse population, providing an opportunity to examine variations among racial/ethnic groups and specific subgroups.Several population-based studies have examined the racial/ethnic variation of selected birth defects in the United States.4–9 In addition, a number of publications from individual states have included racial/ethnic data for either specific birth defects or a range of conditions.10–31 These studies have generally focused on a limited number of racial/ethnic groups or birth defects.Two previous population-based analyses, conducted through the National Birth Defects Prevention Network (NBDPN), provided clues concerning racial/ethnic variation for a range of birth defects using a large US birth sample.6,32 However, these analyses did not adjust for important covariates and only examined differences among Blacks and Hispanics relative to Whites. For the present study, we used more recent pooled population-based prevalence data over a longer period of time and for a wider range of racial/ethnic groups to examine differences in the prevalence of birth defects. Our objective was to examine the racial/ethnic differences in the occurrence of 27 major birth defects in the United States.     

Pneumococcal Serotypes before and after Introduction of Conjugate Vaccines,United States, 1999–2011

Serotyping data for pneumococci causing invasive and noninvasive disease in 2008–2009 and 2010–2011 from >43 US centers were compared with data from preconjugate vaccine (1999–2000) and postconjugate vaccine (2004–2005) periods. Prevalence of 7-valent pneumococcal conjugate vaccine serotypes decreased from 64% of invasive and 50% of noninvasive isolates in 1999–2000 to 3.8% and 4.2%, respectively, in 2010–2011. Increases in serotype 19A stopped after introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. Prevalences of other predominant serotypes included in or related to PCV13 (3, 6C, 7F) also remained similar for 2008–2009 and 2010–2011. The only major serotype that increased from 2008–2009 to 2010–2011 was nonvaccine serotype 35B. These data show that introduction of the 7-valent vaccine has dramatically decreased prevalence of its serotypes and that addition of serotypes in PCV13 could provide coverage of 39% of isolates that continue to cause disease.     

Representativeness of Tuberculosis Genotyping Surveillance in the United States, 2009–2010

Genotyping of Mycobacterium tuberculosis isolates contributes to tuberculosis (TB) control through detection of possible outbreaks. However, 20% of U.S. cases do not have an isolate for testing, and 10% of cases with isolates do not have a genotype reported. TB outbreaks in populations with incomplete genotyping data might be missed by genotyping-based outbreak detection. Therefore, we assessed the representativeness of TB genotyping data by comparing characteristics of cases reported during January 1, 2009–December 31, 2010, that had a genotype result with those cases that did not. Of 22,476 cases, 14,922 (66%) had a genotype result. Cases without genotype results were more likely to be patients <19 years of age, with unknown HIV status, of female sex, U.S.-born, and with no recent history of homelessness or substance abuse. Although cases with a genotype result are largely representative of all reported U.S. TB cases, outbreak detection methods that rely solely on genotyping data may underestimate TB transmission among certain groups.Since 2004, the Centers for Disease Control and Prevention (CDC) has offered routine genetic characterization (i.e., genotyping) of all U.S. tuberculosis (TB) cases with Mycobacterium tuberculosis (M. tuberculosis) isolates.¹ Genotyping is a laboratory method used to determine the relatedness of isolates; although not a perfect measure of transmission,² this tool contributes to TB control in multiple ways. Genotyping data contribute to TB control, including the detection of genotype clusters that might represent remote or recent transmission (including outbreaks).^3–6 TB genotyping data are also important for defining the scope of outbreaks,⁷ monitoring outbreaks over time,⁸ distinguishing relapse from reinfection,⁹ detecting or confirming false-positive culture results,^10,11 confirming known epidemiologic links, and finding unknown links between cases.^3,4,12 The utility of genotyping is limited in populations for which few cases are genotyped, because potential transmission relationships between cases might be missed. TB genotyping is most effective when data are representative of the entire population of TB cases.^13–15Applying TB genotyping data to TB control requires that an isolate be submitted for genotyping and that the genotyping result be linked to the patient''s demographic and clinical information. While some states have independent systems for generating and linking genotyping data, most states rely on the national CDC-funded system. In this system, an isolate is submitted for genotyping to the CDC-funded national genotyping laboratory, and genotyping results are linked to the patient''s demographic and clinical data, which are reported to the National Tuberculosis Surveillance System (NTSS).¹⁶ This linkage is facilitated by a CDC-developed and -funded national Web-based genotyping database, which includes both NTSS and genotyping data.First, specimens are collected from a suspected TB patient. Specimens are generally sent to a jurisdictional public health laboratory for culturing and processing and, when a specimen yields a culture that is positive for M. tuberculosis, an isolate is sent to the national genotyping laboratory. In some cases, a viable culture might not be available to be submitted for genotyping. In other cases, a viable culture might be available but not submitted to the genotyping laboratory. These latter cases represent a missed opportunity for genotyping. Although it is not possible to determine whether or not a viable culture was available for submission from nationally reported data, we can use the presence of drug susceptibility testing (DST) results, testing that requires a viable culture, to identify cases for which a viable culture was likely available to be submitted for genotyping.Once the isolate is genotyped, the result is entered into the national Web-based genotyping database. In parallel with this process, the patient''s demographic and clinical data are submitted to jurisdictional public health authorities for reporting to NTSS; these data are then uploaded into the national Web-based genotyping database. The state TB program is responsible for the critical step of linking the surveillance report to the genotyping result, using a state-assigned identification number. Failure to link the genotyping and surveillance records will result in the case appearing to have not been genotyped. Because surveillance and genotyping data are linked by the state, it is not possible at CDC to distinguish between cases that have not been genotyped and cases that have been genotyped but not linked.National TB genotyping coverage is defined as the proportion of TB cases with a culture yielding M. tuberculosis (referred to as “culture-positive cases”) that are linked to a genotype result in the national Web-based genotyping database. In 2010, national genotyping coverage was 88%. However, approximately 20% of TB cases in the United States are not culture positive and, therefore, do not have an isolate available for genotyping.¹⁷ A case could be missing a genotype result for three general reasons: it did not have an M. tuberculosis isolate, it had an isolate that was not genotyped, or the genotyping result was not linked to NTSS data in the national Web-based genotyping database. Our aim was to characterize cases that did not have a genotype result for any of these reasons to identify populations in which outbreaks might be missed by genotype-based outbreak detection methods, and to identify opportunities to increase genotyping.     

Ciguatera Fish Poisoning and Climate Change: Analysis of National Poison Center Data in the United States, 2001–2011

Background: Warm sea surface temperatures (SSTs) are positively related to incidence of ciguatera fish poisoning (CFP). Increased severe storm frequency may create more habitat for ciguatoxic organisms. Although climate change could expand the endemic range of CFP, the relationship between CFP incidence and specific environmental conditions is unknown.Objectives: We estimated associations between monthly CFP incidence in the contiguous United States and SST and storm frequency in the Caribbean basin.Methods: We obtained information on 1,102 CFP-related calls to U.S. poison control centers during 2001–2011 from the National Poison Data System. We performed a time-series analysis using Poisson regression to relate monthly CFP call incidence to SST and tropical storms. We investigated associations across a range of plausible lag structures.Results: Results showed associations between monthly CFP calls and both warmer SSTs and increased tropical storm frequency. The SST variable with the strongest association linked current monthly CFP calls to the peak August SST of the previous year. The lag period with the strongest association for storms was 18 months. If climate change increases SST in the Caribbean 2.5–3.5°C over the coming century as projected, this model implies that CFP incidence in the United States is likely to increase 200–400%.Conclusions: Using CFP calls as a marker of CFP incidence, these results clarify associations between climate variability and CFP incidence and suggest that, all other things equal, climate change could increase the burden of CFP. These findings have implications for disease prediction, surveillance, and public health preparedness for climate change.Citation: Gingold DB, Strickland MJ, Hess JJ. 2014. Ciguatera fish poisoning and climate change: analysis of National Poison Center data in the United States, 2001–2011. Environ Health Perspect 122:580–586; http://dx.doi.org/10.1289/ehp.1307196